The 245-189 vote was largely along party lines, and cleared the way for the second phase of the "repeal and replace" promise that victorious Republicans made to the voters last fall. GOP officials said that in the coming months, congressional committees will propose changes to the existing legislation, calling for elimination of a requirement for individuals to purchase coverage, for example, and recommending curbs on medical malpractice lawsuits.

Republicans also intend to try to reverse many of the changes Democrats made to Medicare Advantage, the private alternative to the traditional government-run health care program for seniors.

Like the repeal bill itself, these other measures will require Senate approval and a presidential signature to take effect, and the prospect is for months of maneuvering on the issue.

Debate across two days leading to the vote was markedly restrained, as lawmakers in both political parties observed self-imposed vows of civility in the wake of the shooting rampage in Arizona that left six dead and Rep. Gabrielle Giffords wounded.

But there was no mistaking the significance many first-term Republican lawmakers attached to a day they had long waited for, finally getting a chance to speak and then vote on the House floor against a law they had campaigned for months to repeal.

Rep. Jeff Duncan, R-S.C. said the legislation produced by Obama and congressional Democrats was a "job-killing, socialistic" approach to health care. Rep. Frank Guinta of New Hampshire, who defeated a Democratic incumbent last fall, said it was misguided, needing repeal.

"This is not symbolic. This is why we were sent here," added Rep. Michelle Bachman, of Minnesota, a third term conservative with strong support among tea party activists.